静脉动脉体外膜肺氧合患者脑组织氧饱和度与预后的关系  

Relationship between regional cerebral oxygen saturation and prognosis in patients undergoing veno-arterial extracorporeal membrane oxygenation

作　　者：卢艳秋[1] 张飞 王艮卫[2] 李亚辉 黄少轩 周玉阳[3] Lu Yanqiu;Zhang Fei;Wang Genwei;Li Yahui;Huang Shaoxuan;Zhou Yuyang(Department of Critical Care Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Department of Neurosurgery,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Department of Cardiovascular Surgery,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院重症医学科,郑州450014 [2]郑州大学第二附属医院神经外科,郑州450014 [3]郑州大学第二附属医院心脏大血管外科,郑州450014

出　　处：《中华实验外科杂志》2024年第6期1303-1306,共4页Chinese Journal of Experimental Surgery

基　　金：河南省医学科技攻关项目(LHGJ20200415)。

摘　　要：目的探究接受静脉动脉体外膜肺氧合(VA-ECMO)支持患者脑氧饱和度与患者预后的关系。方法前瞻性纳入2020年9月至2022年6月郑州大学第二附属医院监护室91例接受VA-ECMO支持患者。在患者接受VA-ECMO支持后,第一时间获取家属的纸质版知情同意书,对符合要求的患者进行脑氧饱和度监测。在患者前额放置NIRS监测探头对脑氧饱和度(rSO2)进行连续动态监测至少24 h。收集患者的一般资料、入ICU 24 h内的一般生命体征(心率、平均动脉压、呼吸),实验室检查结果(血常规、乳酸),ECMO支持期间多重耐药菌感染情况和彩超检查结果(左心室内径、左心室射血分数)。最终纳入研究的患者分为存活组和死亡组。组间比较,计量资料采用t检验或Mann-Whitney U检验,计数资料采用卡方检验或者Fisher精确检验,绘制受试者工作特征(ROC)曲线,采用DeLong方法比较曲线下面积。结果研究过程中未观察到与脑氧监测相关的不良事件。严重休克患者的病因以急性心血管病为主,包括急性心肌梗死,心衰等。患者的平均年龄约54岁。入组患者的存活率约45%(41/91)。死亡患者的rSO2低于存活患者(51.42%比58.24%,P<0.05)。rSO2是VA-ECMO患者不良预后的独立预测因子,受试者工作特征曲线下面积(AUC)为0.722。当rSO2为56%的截断值时,预测VA-ECMO患者病死率的敏感性(58%)和特异性(75.65%)最高。结论NIRS可用于监测VA-ECMO支持患者脑灌注情况,低脑氧饱和度与患者的不良预后明显相关。Objective To investigate the correlation between cerebral oxygen saturation and prognosis in patients receiving veno-arterial extracorporeal membrane oxygenation(VA-ECMO)support.Methods The prospective study was conducted on 91 patients who received VA-ECMO support in the ICU of the Second Affiliated Hospital of Zhengzhou University between September 2020 and June 2022.The patient’s families were asked to provide paper-based informed consent immediately after the initiation of VA-ECMO support.For eligible patients,cerebral oxygen saturation monitoring was conducted by placing a NIRS monitoring probe on the patient’s forehead to monitor regional cerebral oxygen saturation(rSO2)continuously and dynamically for at least 24 h.The study collected general patient information,vital signs within the first 24 h of ICU admission(heart rate,mean arterial pressure,respiration),laboratory test results(blood routine tests,lactate),instances of multidrug-resistant bacterial infections during ECMO support,and echocardiography findings(left ventricular diameter,ejection fraction).The patients included in the study were divided into a survivor group and a deceased group.Quantitative data were analyzed using the t-test or Mann-Whitney U test,while categorical data were assessed using the chi-square test or Fisher’s exact test for group comparisons.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve was compared using the DeLong method.Results No adverse events were observed.The primary etiology of severe shock among patients was acute cardiovascular diseases,such as acute myocardial infarction and heart failure.The mean age of the patients was approximately 54 years.The survival rate among the enrolled patients was approximately 45%(41/91).Deceased patients exhibited significantly lower rSO2 levels compared to surviving patients(51.42%vs.58.24%,P<0.05).rSO2 was identified as an independent predictor of poor prognosis in VA-ECMO patients,with an area under ROC curve(AUC)of 0.722.The highest s

关 键 词：休克 体外膜肺氧合 脑灌注 脑氧饱和度 近红外光谱 病死率 

分 类 号：R459.7[医药卫生—急诊医学]